Friday, April 07, 2017

An experiment in unstructured living for people with mental health problems

The film Mad to be normal was released yesterday. Almost my first post on this blog was about the plans for this film. As Bob Mullan explains (see iNews article), it has been a "long-gestating project". I first heard about it from him in 2006.

I haven't seen the film yet, but I thought it may be worth saying something about Kingsley Hall (see Guardianarticle), on which the film focuses. Kingsley Hall was the first of several therapeutic community households established by the Philadelphia Association, a charity founded in 1965 by R.D. Laing, David Cooper (although Cooper had nothing more to do with the project after it started) and others. (See extracts on Laing and Cooper from my book chapter 'Historical perspectives on anti-psychiatry'). Laing lived at Kingsley Hall for 18 months in 1965/6. It was an experiment in unstructured living and sought to allow psychotic people the space to explore their madness and internal chaos. It did not attempt to ‘cure’ but provided a place where "some may encounter selves long forgotten or distorted" (Morton Schatzman in Laing and anti-psychiatry).

The local community was mostly hostile to the project. Windows were regularly smashed, faeces pushed through the letter box and residents harassed at local shops. After five years, Kingsley Hall was largely trashed and uninhabitable. Even for Laing, Kingsley Hall was "not a roaring success" (Mullan, 1995). Laing’s dream of a place "without those features of psychiatric practice that seemed to belong to the sphere of social power and structure rather than to medical therapeutics" was only partially successful, even from his own perspective (Laing, 1985).

Kingsley Hall was designed to give people freedom from the social control of psychiatry. As I wrote in my chapter in Liberatory psychiatry, its association

with the counterculture of the 1960s and 1970s may have helped to propel anti-psychiatry into the limelight. It may also have contributed to its demise. Without this cultural support, anti-psychiatry seemed to lose its popular appeal. Also, some of its major proponents, such as Laing, were more obviously interested in personal authenticity than changing psychiatry practically. After Kingsley Hall, Laing went on retreat to Ceylon and India to pursue his interests in meditation, Buddhism and Hinduism. Later in life, Laing (1987) regarded his main achievement as being in the area of social phenomenology in philosophy, not psychiatry. Generally, anti-psychiatry is seen as having had no lasting influence on psychiatry and its practice (Tantam, 1991). For all its calls for liberation, these aspirations were largely sidelined into promoting personal and spiritual freedom with little interest in redeeming psychiatry itself. This diversion helped to allow mainstream psychiatry to marginalise anti-psychiatry’s influence.

I have always said that critical psychiatry has its origins in anti-psychiatry (see eg. my letter). The Philadelphia Association has survived over 50 years and still runs two community houses (see my book review of Testimony of experience). Critical psychiatry has sought to avoid the marginalisation that anti-psychiatry experienced and is looking for acceptance of its position from mainstream psychiatry. Even Laing probably ultimately sought the endorsement of the psychiatric profession as demonstrated by his wish to be professor of psychiatry in Glasgow towards the end of his life.

4 comments:

"unstructured living": not a good idea in my experience of psychosis and having to survive psychiatric treatment in 1978, 1984 and 2002. It required planned action firstly in resisting coercive drug treatment to which I was forced to conform on each occasion. Then, when strong enough, tapering the antipsychotics and taking charge of my own mental health. I couldn't have done this without structure and the support of family. You might describe it as being like a campaign or strategy. An end goal with steps to achieve it. Recovery the aim.

I experienced another psychosis in 2015, a physical and mental health breakdown after years of campaigning for justice following my youngest son's abusive treatment in Stratheden psychiatric Hospital, Fife. Despite winning an Ombudsman case and apology from NHS Fife I didn't feel that justice had been done. Scottish Government awarded £4.4million to the Fife health board following my whistleblowing about the locked seclusion abuses, to build a new Intensive Psychiatric Care Unit, which is now up and running, about half a mile up the road from where we live. The bus we take into Cupar goes by the new unit, stopping to let psychiatric patients on.

My altered mind state or reactive psychosis in the summer of 2015 did not require psychiatric inpatient treatment. Rather I was supported by family and virtually via Email with clinical friends, a doctor and psychotherapist. Both of these men listened to my ramblings non-judgementally, with mutual sharings and humour, a life saver. Social networking was a useful outlet. Plus I took Lorazepam on two separate nights to get my sleep pattern back on track, removing any stimuli like TV and books from the bedroom. Not sleeping through the day even if tired. I took up various activities again, to relax, including knitting, sewing, swimming, fitness, eventually cycling which I hadn't really done before, seriously. Now I have 3 bikes.

Regarding the Philadelphia Association Community Houses in London, I tried to visit them in July 2016, via Dr Bruce Scott who I know, in preparation for my PhD research into Safe haven crisis Houses, starting this September at the University of Edinburgh, Clinical Psychology department. However this wasn't possible. I did manage to arrange a visit to the Drayton Park Women's Crisis House, Camden and Islington NHS Foundation Trust, meeting with Shirley McNicholas who developed this resource over 21 years ago and is still the Manager. This was a positive experience, seeing the facility and learning about the organisation. I've also visited the Leeds Survivor Led Crisis Service, back in 2011, and hope to revisit during my research, which will be to evidence good practice, a mixed methods approach, qualitative and quantitative, hearing stories and gathering information about management and leadership styles, budgets etc. Focused research and a larger scoping or mapping exercise.

I want to see alternative (to psychiatric inpatient treatment) respite crisis support for people experiencing psychosis in Scotland. Choices of therapy, not just medication/drugs. And support in tapering psychiatric meds by psychiatrists, psychologists and peer workers, people with lived experience of coming off prescription drugs and making a full recovery. As I did and others have done. Our testimonies should be an important part of the mix, at the table during clinical meetings, alongside diagnoses and drug prescribing. Rather than on the periphery in blog posts and tweets, or in case studies and "vignettes".

Always pleased to listen to what you say Chris. People have different takes on Laing so best to read several accounts. Bear in mind though he didn't look after anybody himself- that was delegated to the minions. Totally with you re the nonsense of publishing 'vignettes'. They are a way of avoiding the obligation to get written consent for use of people's personal material and being a mix of fiction and faction cannot be verified. Those who use such devices can claim that they are not using without consent. Strange way for a theories to be developed and worse - practiced on others. For an example of this deceit see The 205 Bowlby conference where sections are blocked out - but sensitive material was 'shared' with an audience of therapists and whoever could afford the attendance fee. Brett Kahr. therapist and one of the leading lights promoting Bowlby and attachment theory has stated that he and some other psychoanalysts are thinking of publishing without adding the authors' names - to avoid clients being able to discover their publications via the internet etc . There have been a few notable health workers such as Suman Fernando and members of critical psychiatry who have been banging on about the state of psychiatry for decades but some the follwers of Laing claim it was a stage of youthful rebelliousness - One flew out of cuckoos nest is criticised as bring psychiatry into disrepute - as if it could be any further..Another voyeuristic film of 'mad people' won't improve anything - it just continues the tradition of visits to the asylums in Victorian times - and the outrageously offensive practice of 'the team' sitting around together to discuss 'a case' with the individual under scrutiny being forced to play their game. One day.........just maybe things will change.

I remember a MH nurse educator in Fife saying that people with "lived experience" couldn't be involved in training sessions with staff because they used real scenarios, spoke about patients by name. I thought this was bad practice and said so. The guy is now a MH nurse lecturer in a university.

One flew over the Cuckoo's nest film I think had a major positive effect on ECT practice, in terms of treating folk with psychosis. I noticed it in Scotland between 1978 and 1984 when I was a patient. Second time around they weren't trying to force shock treatment on to me. Just Chlorpromazine/Largactyl. First time I managed to escape it by running out of ward in pyjamas, aided and abetted by my husband. Then they used to lock our clothes up, make us wear pyjamas in mixed gender dining room areas. Shameful. I think it may still be happening in Ireland.